GOUT Flashcards
indomethacin
- NSAID
- primary NSAID used in tx Acute gouty Attacks
- Nonspecific reversible inhibitors of COX01 and COX-2 enzymes
naproxen (Naprosyn)
- NSAID
- tx Acute gouty Attacks
- Non-specific reversible inhibitors of COX -1 and COX-2 enzymes
Colchicine
- Used for acute gout attacks
- binds to tubulin; inihbits assembly of microtubules -> produces anti-inflammatory effect by preventing phagocytosis
probenecid (Benemid)
- Uricosuric agent
- tx of hyperuricemia
allopurinol (Zyloprim)
- Xanthine oxidase inhibitor thus inhibits synthesis of uric acid
pegloticase (Krystexxa)
- mammalian urate oxidase enzyme that converts uric acid to allantoin
- readily excreted
rasburicase (Fasturtec)
- recombinant form of urate oxidase (not endogenous in humans) that converts uric acid to allantoin
- readily excreted
gout patients may be of what two types
- overproducers of uric acid
-
underexcreters
- renal excretion of uric acid is low
problem with hyperuricemia?
- uric acid not water soluble so in big concentrations will come out of solution and form crystals which produce inflammatory response
urate crystals are by synoviocytes, initiating an inflammatory reaction mediated by prostaglandins and cells of the immune system
- phagocytosed
can aspirin be used to treat gout
- asa, salicylates are contraindicated
- they decrease urate excretion in the kidney
- both acids
Treatment of patient with
- active PUD
- not active PUD
- No hx of PUD
- acetaminophen or opioids **no NSAIDs,
- celecoxib
- NSAIDs
which drugs can be used in the acute treatment of gout
- NSAIDs
- indomethacin
- Colchicine
how can glucocorticoids be used in the treatment of gout
- inhibit phospholipase A2 which is responsible for arachidonic acid, the rate limiting step in synthesis of prostaglandins
how long does it take for Colchicine to be effective
- 12-24 hours
adverse effects of Colchicine
- diarrhea
function of uricosuric agents
- incrase the urinary excretion of uric acid by blocking the active reabsorption of uric acid in the proximal tubule
why should a large volume of be probenecid (a uricosuric agent) used
in order to minimize the possibility of kidney stone formation
iniitial administration of probenecid may do what
- trigger gouty attack
- combine with colchicine - prophylactic colchine therapy
side effect of probenecid
- Decrease excretion of acidic compounds (penicillin, methotrexate)
when should probenecid therapy be started
- should not be started until 2-3 weeks after an acute attack
- may aggrevate gout symptoms if given during acute attack
MOA of Febuxostat (uloric)
- inhibits xanthine oxidase and thus inhibits synthesis of uric acid
side effects of xanthine oxidase inhibitors
- vasculitis
- agranulocytosis
what should you consider when starting xanthine oxidase inhibitor therapy
- initial therapy may provoke acute gouty attack,
- colchicine proplhylaxis may be necessary
what effect does aluminum hydroxide and other antacids have on xanthine oxidase inhibitors (allopurinol, febuxostat)
- decreases their absorption
what effect does the xanthine oxidase inhibitors (allopurinol, febuxostat) have on mercaptopurines (chemotherapy drug)
- increases their effect
what effect does the xanthine oxidase inhibitors (allopurinol, febuxostat) have on warfarin
- inhibits the metabolism of warfarin
how is rasburicase (Fasturtec) administered
- IV
adverse reaction of rasburicase (Fasturtec)
- severe hypersensitivity: anaphylactic shock
